Inspectors identified 23 areas of improvement in care of the elderly

A series of failures at Edinburgh Royal Infirmary have been highlighted in a damning new report, prompting fears that elderly patients could be falling victim to “neglect” while being treated in the flagship hospital.

A team of inspectors who carried out an unannounced probe into elderly care found examples of patients’ dignity and comfort being compromised, while serious concerns over nutrition and the treatment of those with dementia also emerged.

On several occasions the inspection team, which singled out 23 areas for improvement and just four areas of strength, had to intervene themselves after witnessing the poor standard of care. Health Secretary Alex Neil branded the findings “completely unacceptable” as NHS Lothian issued an apology to patients who had received sub-standard care.

During the three-day inspection in late August, the Healthcare Improvement Scotland team:

• Was forced to step in after a patient with a learning disability was left “uncovered and exposed” in a busy assessment area.

• Noted that some staff referred to patients by their bed or room numbers, rather than names.

• Found that ward staff were unaware that one patient had lost 10kg in one week.

• Criticised processes surrounding do not resuscitate orders, saying there was no documented evidence that there had been discussions with patients and their families regarding decisions.

• Discovered evidence of patients with dementia being moved around wards because of pressure over beds, potentially increasing their confusion.

• Had to ask a senior charge nurse to come out of a meeting to make sure a patient was fed, after he was left with soup on his left side despite his left arm being in a plaster cast.

• Saw a partially sighted patient eating a meal with their fingers, as their cutlery was placed out of view.

Norman Irons, who served as the city’s Lord Provost between 1992 and 1996, raised concerns about the treatment his 89-year-old mother Anne had received at the ERI in the weeks before she died there in 2005. In the wake of Ms Irons’ death and an Evening News investigation, an independent probe was launched into the care of pensioners at Lothian hospitals and called for wide-ranging reforms. But seven years on, Mr Irons expressed his horror after reading the latest report, which he said brought back painful memories.

“Very little appears to have changed. It’s distressing because we were promised that things would improve,” he said.

“Now other families are watching their mothers, fathers and grannies going downhill because of neglect. They don’t like people using that word, but that’s what it is – these paragraphs describe neglect.

“I’m aware there’s a new chief executive at NHS Lothian. The first thing he has to do is look at this appalling state of affairs. If he doesn’t, the Health Secretary should be looking urgently at this report.”

Mr Neil said the inspection report “highlighted a high number of examples of poor care being provided to older people”.

He added: “I expect NHS Lothian to give urgent attention to the action plan it has produced to address these issues, in particular to ensure that staff are consistently implementing the board’s own policies and guidance and providing compassionate care which respects patients’ dignity and individual needs.”

Labour’s shadow health secretary, Jackie Baillie, labelled the findings “shocking” and said government cuts had left nurses “at breaking point”.

Her colleague, Lothians MSP Sarah Boyack, added: “As this report makes plain, over-stretched resources are preventing proper care being delivered. When inspectors need to step in to ensure patients are fed properly and to ensure that patients are treated with dignity, then we know something is seriously wrong.”

The Royal College of Nursing said it had offered to take action to support management and staff at the ERI, in a bid to “turn this situation around”.

Inspectors said the majority of elderly patients at the hospital praised the care they had been given, while processes around establishing proxy powers of patients’ representatives, a psychiatric liaison service, choice of meals and training offered around wound care were singled out as areas of strength.

But Jackson Carlaw, Tory health spokesman, said the report amounted to “another embarrassing revelation” for NHS Lothian. He said: “It is clear from this report that levels of care at one of Scotland’s biggest and most expensive-to-run hospitals fall far short of an acceptable standard.

“NHS Lothian cannot simply brush this report off with glib words about trying to make a change. When failings like this are uncovered, urgent action and accountability are needed and can’t be swept under the carpet.”

Melanie Hornett, NHS Lothian’s nurse director, said: “NHS Lothian is committed to providing high-quality, safe and person-centred care and I am extremely disappointed in the findings of this report. I would like to apologise to patients who have experienced care that was below the standard we expect.

“We already have a number of polices and procedures in place to improve care for older people in our hospital and the inspectors did identify areas of good practice. But it is clear that we need to do more to ensure that these polices and procedures are being carried out consistently across all areas. We have reviewed the inspection team’s findings and have a detailed action plan in place to address the issues raised.”

Inspections regime is ‘robust’

HEALTHCARE Improvement Scotland was told to produce a series of reports into the standard of care offered to the elderly in acute hospitals in June last year after being set up by then-Health Secretary Nicola Sturgeon.

In April this year, an inspection at the Western General Hospital identified four areas of strength, 12 areas for improvement and two areas of continuing improvement.

After that probe, concerns were raised over dementia screening for elderly patients and nutrition, although patients were generally positive about the hospital and the care they received.

At its announced inspection of elderly care at the Glasgow Royal Infirmary in May, which has around 200 fewer beds than the ERI, four areas of strength, 17 areas for improvement and one area for continuing improvement were found.

Following the publication of yesterday’s report into the ERI, current Health Secretary Alex Neil said: “This report highlights why we asked Healthcare Improvement Scotland to carry out this series of inspections, including unannounced inspections, into the care of older people, and reassures me that the inspection process is robust.”

Analysis

Doug Anthoney

Communications and campaigns officer for Age Scotland

THE report is just the latest in a series that has prompted often less-than-flattering headlines for our hospitals this year. This is healthy, and Scotland-wide we are beginning to get a picture of how hospital care for older people looks in the 21st century.

Let’s be clear; the ERI is not a disaster zone. Overall, patients are positive about their care and there are areas of strength, such as around pressure ulcer prevention and management, which not every hospital shares.

Many weaknesses are shared with other hospitals, for example unsuitable ward environments. However, in some areas performance does seem particularly weak.

Older people sometimes arrive at hospital malnourished, so it’s critical that mealtimes are effective. Yet the inspection found them to be ‘poorly organised’ and inspectors felt at times compelled to intervene.

Contrast this with Dumfries and Galloway Royal Infirmary where “relatives and carers are encouraged and supported to come into hospital and help at mealtimes”.

There is no such thing as a perfect hospital, and overall NHS managers need to raise their game if we are to give our older people the care and dignity they deserve.

We also need to ask what kind of hospital care we expect for ourselves, and for those we love, in later life. And how much we are prepared to pay for it.

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